It prompted the RACGP, through Dr Ackermann, to call for an end to referring children to chiropractors and for GPs to “seriously reconsider” referring any patients to chiropractors.

“This is a public safety issue,” Dr Ackermann told MJA InSight. “[Situations like the one in the video] are an accident waiting to happen, and the medical profession has condoned it with our silence.”

Both the Chiropractic Board of Australia (CBA), and the Chiropractors’ Association of Australia (CAA) had failed to act on complaints of misleading advertising, Dr Ackermann said.

“They say there’s going to be a reform, but those complaints remain largely unresolved.

“The Chiropractic Board cannot address the scope of practice issues, and that leaves them with no credibility.”

Late last week the president of Chiropractic Australia (CA) — a moderate splinter group formed last year in reaction to numerous controversies plaguing the CAA — said the RACGP stance was doing chiropractors “an injustice”.

In an interview published in Australian Doctor, Professor Rod Bonello said: “It’s entirely reasonable to be very frustrated with the behaviour of individual practitioners who do the wrong thing, but to recommend that doctors do not refer to chiropractors is an inappropriate response.”

“The reason we adjust the baby is because the parents bring them to us. They’ve usually already been to the medical doctors, they’ve usually already been to hospital … and they come to us in desperation.”

A spokesperson for the CAA referred MJA InSight to a written statement which, in part, reads: “Patients who engage chiropractors are highly satisfied and this is achieved through a patient-centric approach and an informed consent process.

“Chiropractors bring the entire continuum of evidence to their practice. This includes evidence-informed practice, practitioner experience and patient outcome.

“If the same lens and bar was applied to all health professions that is being focused on chiropractors, the public discussion would shift and people would be asking questions of interest and balance of all health interventions not just chiropractic … If the current focus of levels of evidence in intervention is applied equitably to all health professions, then there will be concerns with the role or treatments that some health professions have in the ongoing care of the public.

“As in all professions, there are some practitioners who may not practice at the standard required and CAA works with the regulatory bodies to ensure this is minimised.”

Bernard Rupasinghe, policy manager for the CAA, said that over the past 12 months, the CAA had “significantly strengthened the professional development components of our ongoing education for members”.

“This has actively focused on ensuring members comply with their responsibilities as health practitioners, as regards advertising and social media. This education has been disseminated to members via numerous platforms including written publications, such as our member magazine The Australian Chiropractor, regular email updates and through social media channels,” he told MJA InSight.

Dr John Cunningham, a Melbourne spinal surgeon, said he was surprised it had taken so long for the RACGP to speak out.

“With the exception of acute lower back pain, there is no condition which a chiropractor can treat in any way better than a medical practitioner,” Dr Cunningham told MJA InSight.

“In the case of acute lower back pain, yes, chiropractors can get their patients back to work a few hours earlier than analgesics, but that’s it.

“Referring children to chiropractors is a waste of time and money, and it is potentially dangerous,” he said. “You risk missing a legitimate diagnosis by leaving a child with a chiropractor for too long.”

A spokesperson from the CBA told MJA InSight: “The Board doesn’t make comment on behalf of the profession as its role is to protect the public (it has no role in representing or furthering the profession).

“Whether practitioners in one profession refer to another profession or not, only becomes a regulatory issue if practitioners are not referring when their Code of Conduct would require them to. This applies to all 14 regulated professions.”

29 thoughts on “Chiros and kids: time to make a stand”

A direct consequence of the broader attitude in society that is drifting away from embrace of science and Enlightenment values, combined with the notion that there is no such thing as ‘truth’, so we all have to respect each other’s beliefs and accord them equal value. Thus closed-minded traditional medicine is not open to the vistas of possibility offered by ‘alternative’ therapies.

When we live in a society where “I’m right, you’re right, we’re alright” it is indeed very hard to call a spade a spade.

From experience complaining to AHPRA is a waste of time. They have a financial interest in keeping as many “practitioners” paying their fees every year.

Pressure should be applied to the AMA, RACGP and ACRRM to enforce their expectations of their members practicing EBM and expel those who don’t adhere to these principals and refer their patients to non-EBM practitioners . They can form their own college of “Magical Medicine”. On past performance AHPRA will gladly include them as they did with Chinese Medicine practitioners.

There are certainly rational Chiros who only treat musculoskeletal issues, using a combination of physical therapy and sports therapy. The manoeuvres that characterise traditional Chiro, though, like high velocity thrusts and mechanical ‘clickers’, and the model of ‘adjustments’, are not evidence-based. It’s no surpise that some disillusioned Chiros have ceased training, or left the profession, or re-trained as physios. It should not be too difficult to have a single discipline of Physical Therapy, based on science, with people sub-specialising in different areas of practice – respiratory, rehab, sports etc.

There are and always have been multiple legitimate approaches to the problem of alleviating human suffering. Monopoly is bad medicine.

John Bohannon, a biologist at Harvard, recently submitted a pseudonymous paper on the effects of a chemical derived from lichen on cancer cells to 304 journals describing themselves as using peer review. An unusual move; but it was an unusual paper, concocted wholesale and stuffed with clangers in study design, analysis and interpretation of results. Receiving this dog’s dinner from a fictitious researcher at a made up university, 157 of the journals accepted it for publication. http://www.economist.com/news/briefing/21588057-scientists-think-science… People who live in glass houses shouldn’t throw stones.

Chinese Medicine Practitioners have been in the business of healing people for thousands of years. Something Allopathy can not lay a claim to. Many of the past cures now have solid research science behind them to validate their efficacy. They also do not have a closed mind and use ‘Integrative hospitals’ that combines the best treatments with Allopathy, so that the patient receives the best care.

The combined RACGP, AMA, should be able to scrape together at least one intelligent rational person, instead of acting like a street gang, known for intimidation and bullying (current Senate inquiry). One video clip, without investigation, & based on that you want to eradicate a whole profession. Thats IRRATIONAL. None of you loud mouths are actually trained as Chiropractors, so your NOT qualified to be judge, jury & executioner. You ignore evidence becuase it suits you, intimidate with words like, bone-cracker, crack-addict, child-abuser, bone fiddling jeddi, on a background of a Royal commision level of iatrogenesis, unnecessary procedures, deaths, and abuse of Tax payers money. Twice the amount of serious compaints of any of the health professions, and then claim moral high ground & acaedemic superiority.

You try to restrain Chiros from university and access to research, then demand research. Hypocrites! Stating: “You risk a legitimate diagnosis by leaving a child with a Chiropractor” You’re a conceited piece of work. We took our children to you first, you couldnt help us. ‘All in our minds’ you said. Your tactics being used were already used during WWII. You are a HUGE burden on Tax Payers, some of you charge outragous amounts. The Chiros are not costing the Taxpayer, and are getting amazing results. They dont use the media to comment on your profession, like the venemous tirade soming from your ilk, & your new political head-kickers called FOSIM. Your aggressiveness has absolutely nothing to with patient safety, its about EXTERMINATION. Im a patient, and you should hang your heads in absolute shame.

What is there to say after the above rant by ‘a patient with rights’. Firstly to point out that the taxpayers of this country in fact do fork out for your beloved quacks, bigtime. The above ‘patient’ does seem rather vitriolic and gives the impression of being ‘unencumbered by intelligence and impervious to facts or logic’. As Mr Barnham of Barnham and Bailey Circus fame wryly observed of his particular side show that had snake-oil salesmen aboard: ‘You never go broke under-estimating the taste or intelligence of your audience.’.

I believe that if the genrral public and especially Medical doctors where provided with the history of the “INVENTION” of chiropractic and add to this the lack of scientific evidence of the benefits of the Chiropractic industry , would make a substacial contribution to managing the issue.

I have practiced radiology since 1967 and would like to pass comment on “chiropractic practice.An acute disc bulge is a very common occurence in clinical practice. Symptoms almost ALWAYS subside WITHOUT any treatment apart from analgesia. Chiropractic prospers around this natural history. The patient goes to the chiro in the acute phase. Chiro “manipulates” spine. Pain naturally subsides in a short space of time. Chiro cops the kudos for this natural event and takes his fee. Patient returns to chiro at the slightest back tinge “for an adjustment”. More fees. Pateint swears by his chiro. Radiologist asked to x-ray WHOLE spine even if pain is only confined to the lumbar or even only the neck region. MASSIVE unnecessary dose of radiation, particularly to the pelvis of a fertile female and children, especially those with a CONGENITAL anomaly! Radiology then goes on to create VERY POWERFUL spinal imaging technology such as CT and MRI. All radio!ogists have seen cases where a simple acute bulge is converted to a frank rupture of a hitherto intact annulus fibrosus, by overzealous manipulation. The central disc material is extruded through this defect to impinge on the nervous structures in the central spinal canal, severely irritating them. Patient needs urgent surgery to fuse disc and clear the canal of this material. Patient now in agony. Radiologist prohibited from blowing the whistle. We see it all. I have yet to see an acute disc bulge DECREASED by zillions of manipulations by chiros. Where IS this EB material they constantly rabbit on about? What evidence?. In all my years of radiological practice I have never seen any visible benefit, even using the most powerful imaging. Sacred cows almost! They have gotten away with this for so long.

There really should be some restriction on who is able to use the title “Doctor”. If I were to call myself a “police officer” I would be prosecuted.

If you can’t walk in to A&E and take the next case on the board, if you can’t pull up at a bus crash and get stuck into saving people, if you have to qualify what you actually are when you call yourself “Doctor”, then you have no right in using the title (with the unfortunate but long-standing exception of PhD recipients).

We all worked hard and met the high standards required for our titles. We should resist the watering down of something that we should be rightfully proud of. Why can’t something be done to prevent quacks from calling themselves doctors???

Seems like “someone” forgot to talk with the parents about normal progressive behaviour in neonates. Who diagnsed the colic? the parents..the doctors they had previously consulted… the chiropractor.??? It seems to be a 4 day old baby who has been labelled as having colic, has had the underlying diagnosis missed. How did a chiropractor get their hands on a 4day old “premature” infant anyway?

Dr Bill, I think you’ll find that “doctor”, Latin for “teacher”, has been used as an academic title within universities for the past thousand years. The term has more recently been used as an honorarium for medical practitioners.

So, the ‘unfortunate’ use of the term by PhDs is probably here to stay.

I’m ashamed to be your colleague! How bigoted can some intellectual academics be is just mind blowing.
1. You want to prosecute him for treating his own child with such a gentle pressure that some of you might not even qualify it as a placebo. What’s more at no point did his child look distressed. I bet if any of us was doing the check up she would have been distressed. So what’s this malice child abuse accusation based on??!
2. All of us check our kids whenever there’s a need. Next time your child’s distressed try wasting half a day taking them to your local ER or medical centre instead of doing a quick caring check up yourself! How practical & logical would that be?
3. In all of the cases he’s put up all his “victims” are leaving his room much less distressed than when they walked in. Shouldn’t we all aspire to do that?
4. There are good and bad practitioners in all fields but this one to me looks like a very competent and caring one. You guys are barking up the wrong tree in this case.
5. Surgery isn’t backed by double blind studies. Many studies indicate a strong placebo effect too, e.g. knee surgeries. But we’re not about to ban referrals for surgeries even though the risks are so much higher. Use common sense!

Many commenters here have misunderstood that the issue here goes well beyond the video that has been posted. A significant number of Australian Chiros treat newborns for the ‘subluxations’ they say occur due to ‘birth trauma’. This is well documented. It’s not just a fringe movement. QUite apart from the potential danger, even gentle ‘adjustment’ of things ‘out of place’ is a scam. These providers con parents into thinking that there is something wrong with the babies that needs fixing.

This is not about turf wars, limitations of surgery, Big Pharma or calming children – it’s the provision of false treatment for an incorrect diagnosis, by regisered health care professionals, and should be stopped, as should scam ‘treatments’ in any profession.

Third time Editor: David, when you talk about money to quacks you are talking about yourself. I can get a medicare rebate going to a medic, but none on going to a chiropractor. I wonder how you would fare in the real world if your treatment ceased to be subsided and you were on a level playing field. The scare of a $5-$7 level sent many people to the ED. Your gravy train ride is coming to an end. You might have to be nice to patients in future. You didnt even refute any of my argument in the first post, because it is true. Then exactly as I outlined, assumed a power position, disregarded the patient, and then resorted to name calling… and you call me ‘unencumbered by intelligence’ Why to you think we go to other health professional? Because of the rude, arrogance, and ignorance you have displayed here. Sue Ive never met a disillusioned Chiropractor, met maybe one who was not happy and downgraded to a physio. Its not unusual for health professionals to have two professions, but it is not a fact for political point scoring.

The 50yr practice radiologist, probably in your mid 70’s or early 80’s awesome service. However, lots of illnesses are 3 day self limiting, the foundation of the worried well who see the GP. In relation to dosage, if it was wrong, or illegal, why were you doing it? A search, reveals some cases of what you allege, but many thousands more under the hands of people from your profession. Needs perspective. Time for retirement when you talk whistle blowing and using words like zillions, rabbit and sacred cow. If you were doing unnecessary procedures, you might need to pay that money back to medicare. Now wouldnt that be interesting. Evidence Sue ? re last.

The chiropractic profession has two types of critics, The carpet bombers and the critics who point out the BS and support reform. The statement from the RACGP is the first. I share their frustration with that video but carpet bombing the profession does not further reform. The vitalist subluxation based chiropractors claim that babies are born subluxated which in my view is akin to “original Sin”. Plays on the parents fears and guilt and is scare care! Totally unacceptable!

Should the RACGP and the AMA be critical? Yes! Should all chiropractors follow evidence based guidelines, employ best practice follow research and adhere to CBA/AHPRA rules? Absolutely! Studies fron the USA, Canada, Europe and Australia put the vitalist fringe consistently at 15-18% of the profession. This % closely correlates with anti-vaccination beliefs. The recent clamping down on anti-vaccination chiropractors, 150 of which belonged to the AVN (out of 4500 in the profession) was a good result. I support health and prevention so supporting vaccination is therefore a no-brainer! Reducing the fringe to the lowest possible % takes reform and the support of the RACGP would help otherwise reform and reformers becomes unacceptable collateral damage!

Dr John Cunningham discussed Acute low back pain (LBP) which is a poor choice. Acute LBP wi resolve in the majority of cases no matter what the chiro, physio, Dr or patient does or doesn’t do! The patient could stand on one leg and whistle dixie and they would get batter. The 20% who go on to develop chronic LBP are a different kettle of fish. I shared Dr Cunninghams view on chiropractics evidence base until I read the 2008 special supplenemt of “The Spine Journal” on “Evidence-informed management for chronic low back pain”. It was brought together by Dr Scott Haldeman (Chiro, MD, PhD, Neurologist, prolific auther and researcher). See Here:

Chiropractic stacks up well when compared to other approaches so the next question is what is the risk/benefit and cost benefit and chiropractic again comes out as low risk and low cost!

Its time to reform and one area where we can agree and work together would be a standardized Adverse Event (AE) reporting system in hospital A & E’s for all professions (Chiro, physio, osteo, etc) Correct, accurate reporting that is then sent to the relevant board for investigation. There was a recent article by neurosurgeons on chiropractic AE reports. They found the medical reports to be of poor quality and high risk of bias.

In general I agree with ‘Critical Chiro’ – except for one major point – the subluxation-based part of the profession is not a ‘fringe’ movement. Even the estimated 18% ‘vitalists’ – almost a fifth of the entire group – cannot be considered a ‘fringe’ group. (Vitalists believe in an innate force that heals.) Then, the proportion that describes chiro as ‘adjusting’ a ‘bone out of place’ that is ‘interfering with the nervous system’, and/or recommend ‘wellness care’ and claim that adjustment ‘boosts immunity’ is sizeable – a quick look at websites will confirm this.

It seems that, despite the science taught during training, new graduates are open to this magical thinking – whether to build up their practices, or just because they feel they are doing something special. Somehow, their courses have failed to make them critical thinkers.

So, there aren’t just two camps of critics – there are two camps of Chiros. There are the ones who provide physical therapy for musculoskeletal pain and sports injuries – much like physios. Then, there is a sizeable proportion who ‘adjust’ for non-existent ‘subluxations’, claiming that they are eliminating ‘nerve interference’ and improving overall health.

If the magicians were a small fringe group, it would be relatively easy to regulate them away. But they aren’t. It seems to me that it is time for a split. Vitalists can relinquish their registration, and continue to do magical stuff, without official approval. The rational therapists would probably be better to work together with physios as musculoskeletal and sports physical therapists, with a spinal specialisation.(end of part 1)

(Start of part2) Adverse events need to be seen in context. Detractors of medicine like to quote adverse event rates for the WHOLE medical system – which is the fall-back system for ALL illness and injury, in all-comers, of all levels of severity and urgency, at any time of day. This is hardly a comparator for a narrow discipline that treats musculoskeletal issues in well people.

Here is an important principle: the risk needs to be weighed against the benefit. If the treatment is not for a life-threatening issue, the adverse event rate should approach zero.

But an irony remains: the reason we know about adverse event rates in medicine is that they are tracked, investigated and reported. Life-threatening adverse events for medical treatment mechanical back or neck pain are almost unheard of.

I agree with every point you make Sue and your comments mirror similar conversations I have had with chiropractors who support, advocate and push reform. We are already on the same page, we just have to communicate more! There are two chiropractic camps as there are two critical camps. The vitalists and the carpet bombers need to be reduced to the lowest % possible! Chiropractic needs to clean house but we can learn and get help from the medical reformers and the critical culture that is an integral part of medicine. There may be many problems within medicine but the public trust the doctors to learn from their mistakes and improve care. We need to develop the same trust and foster the same critical culture! The vitalists sprouting their garbage are actively trying to stymie reform and the carpet bombers make reform more difficult.

The subluxationists have been booted from the universities in Australia so they have to peddle their dogma at events like Dynamic Growth Congress here, CalJam and Mile High in the USA and Edinburgh Lectures, ChiroEurope and Rubicon in Europe. It is the same small group of high priests at all these events. Targeting these 12-20 guru’s instead of their camp followers would have greater impact and help reform. I have observed (pardon this anecdote) that the more threatened the camp followers feel, the more they cuddle up to the guru’s to get a warn fuzzy feeling to support their beliefs!

Any adverse event, no matter how rare, is going to present to a hospital emergency. Accurately reporting such events and not assuming what the chiropractor did or didn’t do, is important. Doctors are good at tracking adverse events and have the systems in place. We can learn from you!

I have recently been struggling with quite severe shoulder issues and I go to an outstanding chiropractor who has a very holistic approach to health so much so that he suggested that I see my doctor about a possible cortisone injection preceded by an ultrasound. But this medical intervention alone has not made a diffence without the continued chiropractic treatment and recommended exercises. I am sure that there are a lot of similarly fine chiropractors which makes the discrediting of the professional overall a bit rich – and as if there have never been any incompetent doctors!

I am truly amazed that we still have these debates in this enlightened time of evidence based medical practice. We have to address the problem of charlatanistic practices as a matter of urgency. Not only because of the risk to health, but also because of the large amounts of money that are spent on these falacious practices. I would certainly welcome my contributions to my Private Medical Fund to be reduced once the funding of these false practices are stopped.

@ Deon – these false practices? What false practices? Whenever Allopathy sees itself losing its monopoly, it wants another legislation put into place to prevent another practice from gaining credibility.

(1) Dr Death – linked to 87 patient dealths… (2) Cocaine – addicted doctor – while under the influence… (3) Anaesthetic nightmare – scarily aware for two hours horrified tohear the surgeon listening to disco music… (4) Twins die in hospital bungle – Doctors had advised a pregant mother one of her twins was no viable tue to a congenital heart defect, the wrong baby was terminated… (5) The Butcher of Bega – gynaecologist mutilated and harmed hundreds of women in the small rural town… cont…

In an article by John Raymond Baker, Allopathic Medicine and Adverse Outcomes: The Iatrogenic Problems Continue; http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=31900 Quote ” We should make people aware to the uncertainties of medicine. Not everybody will be cured and in some cases disasters will occur. That’s reality. Medical practice, by necessity, always will be based on trial and error.

– The American Medical Association’s Roy Schwarz, MD, group vice-president of scientific education and practice standards – Death, disease, mutilations, and more: It is a world war or international terrorism? No, we are talking about the outcome of medical procedures being carried out every day by MDs practicing allopathic medicine. “Unquote

— Adverse events from antibiotics cause an estimated 142,000 emergency department visits per year in the United States, according to a study published in the September 15, 2008 issue of Clinical Infectious Diseases. An important reminder for physicians and patients that antibiotics can have serious side effects and should only be taken when necessary…. Web address: http://www.sciencedaily.com/releases/2008/08/ 080812135515.htm

Company hid Prozac, suicide link… Champix heart problem links… etc.

I could look up the internet for even more up to date tradgeties. But it is not my intention to bag Allopathy or any other legitimate profession, half of which the skeptics don’t know much about, but like all propoganda, jump on the bandwaggon by someone else’s call to try and eliminate without doing their own research.